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Wiedenmayer N, Vollmer AS, Winkler JK, Enk AH. Successful Treatment of Severe Pemphigus Vulgaris with Reduced Side Effects Using a Novel IVIg Preparation. Dermatol Ther (Heidelb) 2024; 14:1969-1974. [PMID: 38865042 PMCID: PMC11265024 DOI: 10.1007/s13555-024-01191-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 05/21/2024] [Indexed: 06/13/2024] Open
Abstract
Pemphigus vulgaris (PV) is a rare autoimmune bullous dermatosis (AIBD) characterized by painful blistering of the skin and mucosa caused by autoantibodies that lead to loss of adhesion in the epidermis. Standard therapy for PV is corticosteroids, either alone or in combination with steroid-sparing immunosuppressants or infusions with rituximab. According to the published European guideline, high-dose intravenous immunoglobulin (IVIg) therapy with a dosage of 2 g per kg body weight distributed over 2-5 days every 4 weeks is a promising treatment option, especially for severe or refractory disease. This report describes a 73-year-old female patient with severe and recurrent disease who achieved stabilization with IVIg treatment. However, the patient experienced side effects such as headaches, nausea, and vomiting, which affected daily life. Hence, she was transitioned to a new IVIg preparation with a new manufacturing process, resulting in fewer side effects and an improved quality of life. Further follow-up is necessary to fully evaluate the effectiveness and tolerability of this new IVIg product.
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Affiliation(s)
- Nadine Wiedenmayer
- Department of Dermatology, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Anastasia S Vollmer
- Department of Dermatology, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Julia K Winkler
- Department of Dermatology, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Alexander H Enk
- Department of Dermatology, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
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2
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Feng X, Zhou X, Zhang X, Xiao Y, Li F, Mi W, Gao J, Wang J, Zhou Y, Wang M, Wang W, Li W. Treatment with immunosuppressants did not increase the risk of COVID-19 in pemphigus patients: A single-center survey-based study. Int Immunopharmacol 2024; 135:112307. [PMID: 38796966 DOI: 10.1016/j.intimp.2024.112307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/28/2024] [Accepted: 05/16/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND The prevalence and outcomes of coronavirus 2019 (COVID-19) among patients using glucocorticoids and immunosuppressants remain controversial. AIM The study aims to investigate the impact of immunosuppressants especially glucocorticoids on patients in the Autoimmune Bullous Diseases Cohort of West China Hospital (AIBDWCH) during COVID-19. METHODS We conducted a cross-sectional survey from December 7, 2022, to February 8, 2023, using questionnaires administered either face-to-face or by phone. COVID-19 cases were classified as confirmed, probable, or suspected according to World Health Organization criteria. Patients were divided into Group A (confirmed and probable cases) and Group B (suspected and other cases). The impact of glucocorticoids and immunosuppressive agents on COVID-19 disease and progression was evaluated with logistic regression models. RESULTS This study included 111 patients with pemphigus. Overweight patients had a reduced risk of confirmed COVID-19 (odds ratio [OR] 0.35 [95 % CI 0.13-0.97], p = 0.045). Patients treated with a medium dose of prednisone during the pandemic had a lower incidence of COVID-19 compared to those on low doses, though the difference was not statistically significant. No independent effects of age, sex, comorbidities, and therapies were observed. No significant differences were found in COVID-19 symptoms among different therapy groups. CONCLUSIONS Treatment with immunosuppressants, particularly glucocorticoids at low-to-medium doses, did not elevate COVID-19 risk in pemphigus patients. Consistent outcomes across treatments confirm the safety of these therapies during the pandemic.
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Affiliation(s)
- Xun Feng
- Department of Dermatology & Venerology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xingli Zhou
- Department of Dermatology & Venerology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiwen Zhang
- Department of Dermatology & Venerology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yue Xiao
- Department of Dermatology & Venerology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Furong Li
- Department of Dermatology & Venerology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wenyao Mi
- Department of Dermatology & Venerology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jingya Gao
- Department of Dermatology & Venerology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jinqiu Wang
- Department of Dermatology & Venerology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yunqi Zhou
- Department of Dermatology & Venerology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Mingqi Wang
- Chinese Evidence-based Medicine Center and Cochrane China Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wen Wang
- Chinese Evidence-based Medicine Center and Cochrane China Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Wei Li
- Department of Dermatology & Venerology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Moghadam FS, Kianfar N, Dasdar S, Samii R, Farimani Z, Azar PM, Balighi K, Abedini R, Soori T, Farid AS, Mahmoudi H, Daneshpazhooh M. Adverse outcome and severity of COVID-19 in patients with autoimmune bullous diseases: A historical cohort study. Dermatol Ther 2022; 35:e15672. [PMID: 35768959 PMCID: PMC9349909 DOI: 10.1111/dth.15672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/22/2022] [Accepted: 06/25/2022] [Indexed: 11/28/2022]
Abstract
The ongoing COVID-19 pandemic has raised concerns regarding the outcome of this infection in patients with autoimmune bullous dermatoses (AIBDs) due to effect of drugs used to treat these disorders. This investigation was performed from the onset of the pandemic to June 1, 2021. Patients with AIBDs who contracted COVID-19 were evaluated. A generalized linear model was employed to find the predictors of severe COVID-19 among patients with AIBDs. Ninety-three patients with AIBDs with a mean age of 50.3 years were evaluated. The most COVID-19 related symptoms were tiredness (76.3%) myalgia (69%), and cough (63.4%). During follow-up, the rate of hospitalization and death were 45.2% and 4.3%, respectively. Previous comorbidities (β = 0.61) and mean prednisolone dosage above 10 mg/day in the last 3 months (β = 1.10) significantly increased COVID-19 severity. Also, vaccination against SARS-CoV-2 (β = -1.50) and each passing month from the last rituximab dose decreased severity (β = -0.02). Notably, 19.3% of the patients developed AIBD flare-ups following COVID-19 infection. Higher prednisone dose and the shorter interval from the last rituximab infusion were determinants of severe COVID-19. Physicians should assess the risk versus the benefits when prescribing the medications. Moreover, vaccination could successfully attenuate COVID-19 severity.
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Affiliation(s)
| | - Nika Kianfar
- Autoimmune Bullous Diseases Research CenterTehran University of Medical SciencesTehranIran
| | - Shayan Dasdar
- Autoimmune Bullous Diseases Research CenterTehran University of Medical SciencesTehranIran
| | - Rana Samii
- Autoimmune Bullous Diseases Research CenterTehran University of Medical SciencesTehranIran
| | - Zeinab Farimani
- Autoimmune Bullous Diseases Research CenterTehran University of Medical SciencesTehranIran
| | - Pedram Molhem Azar
- Autoimmune Bullous Diseases Research CenterTehran University of Medical SciencesTehranIran
| | - Kamran Balighi
- Autoimmune Bullous Diseases Research CenterTehran University of Medical SciencesTehranIran
| | - Robabeh Abedini
- Autoimmune Bullous Diseases Research CenterTehran University of Medical SciencesTehranIran
| | - Tahereh Soori
- Autoimmune Bullous Diseases Research CenterTehran University of Medical SciencesTehranIran
| | - Ali Salehi Farid
- Autoimmune Bullous Diseases Research CenterTehran University of Medical SciencesTehranIran
| | - Hamidreza Mahmoudi
- Autoimmune Bullous Diseases Research CenterTehran University of Medical SciencesTehranIran
| | - Maryam Daneshpazhooh
- Autoimmune Bullous Diseases Research CenterTehran University of Medical SciencesTehranIran
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Danieli MG, Piga MA, Paladini A, Longhi E, Mezzanotte C, Moroncini G, Shoenfeld Y. Intravenous immunoglobulin as an important adjunct in the prevention and therapy of coronavirus 2019 disease. Scand J Immunol 2021; 94:e13101. [PMID: 34940980 PMCID: PMC8646640 DOI: 10.1111/sji.13101] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/31/2021] [Accepted: 09/08/2021] [Indexed: 12/15/2022]
Abstract
The coronavirus disease-19 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) challenged globally with its morbidity and mortality. A small percentage of affected patients (20%) progress into the second stage of the disease clinically presenting with severe or fatal involvement of lung, heart and vascular system, all contributing to multiple-organ failure. The so-called 'cytokines storm' is considered the pathogenic basis of severe disease and it is a target for treatment with corticosteroids, immunotherapies and intravenous immunoglobulin (IVIg). We provide an overview of the role of IVIg in the therapy of adult patients with COVID-19 disease. After discussing the possible underlying mechanisms of IVIg immunomodulation in COVID-19 disease, we review the studies in which IVIg was employed. Considering the latest evidence that show a link between new coronavirus and autoimmunity, we also discuss the use of IVIg in COVID-19 and anti-SARS-CoV-2 vaccination related autoimmune diseases and the post-COVID-19 syndrome. The benefit of high-dose IVIg is evident in almost all studies with a rapid response, a reduction in mortality and improved pulmonary function in critically ill COVID-19 patients. It seems that an early administration of IVIg is crucial for a successful outcome. Studies' limitations are represented by the small number of patients, the lack of control groups in some and the heterogeneity of included patients. IVIg treatment can reduce the stay in ICU and the demand for mechanical ventilation, thus contributing to attenuate the burden of the disease.
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Affiliation(s)
- Maria Giovanna Danieli
- Clinica Medica, Dipartimento di Medicina Interna, AOU Ospedali Riuniti di Ancona and DISCLIMOUniversità Politecnica delle Marche, Clinica MedicaAnconaItaly
- School of Specialisation in Allergology and Clinical Immunology, Dipartimento di Medicina Interna, AOU Ospedali Riuniti di AnconaUniversità Politecnica delle MarcheAnconaItaly
| | - Mario Andrea Piga
- School of Specialisation in Allergology and Clinical Immunology, Dipartimento di Medicina Interna, AOU Ospedali Riuniti di AnconaUniversità Politecnica delle MarcheAnconaItaly
| | - Alberto Paladini
- School of Specialisation in Internal Medicine, Dipartimento di Medicina Interna, AOU Ospedali Riuniti di AnconaUniversità Politecnica delle MarcheAnconaItaly
| | - Eleonora Longhi
- Scuola di Medicina e ChirurgiaAlma Mater StudiorumUniversità degli Studi di BolognaBolognaItaly
| | - Cristina Mezzanotte
- School of Specialisation in Internal Medicine, Dipartimento di Medicina Interna, AOU Ospedali Riuniti di AnconaUniversità Politecnica delle MarcheAnconaItaly
| | - Gianluca Moroncini
- Clinica Medica, Dipartimento di Medicina Interna, AOU Ospedali Riuniti di Ancona and DISCLIMOUniversità Politecnica delle Marche, Clinica MedicaAnconaItaly
- School of Specialisation in Internal Medicine, Dipartimento di Medicina Interna, AOU Ospedali Riuniti di AnconaUniversità Politecnica delle MarcheAnconaItaly
| | - Yehuda Shoenfeld
- Ariel UniversityArielIsrael
- The Zabludowicz Center for Autoimmune DiseasesSheba Medical CenterRamat GanIsrael
- Saint Petersburg State UniversitySt. PetersburgRussia
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)MoscowRussia
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5
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Abstract
Since the beginning of the COVID-19 outbreak, attention has gradually moved from the respiratory manifestations of the disease toward its dermatologic aspects. The need for wearing personal protective measures and their cutaneous side effects, detection of related or specific COVID-19 skin eruptions, and the evaluation of certain risk groups of immunosuppressed dermatologic patients have initiated significant discussions about various therapeutic interventions and, in particular, about biologic therapy for psoriasis and for autoinflammatory, orphan, or malignant cutaneous disorders. Autoimmune bullous dermatoses have been of concern due to their chronic course, at times life-threatening prognosis, and the need for prolonged and often aggressive immunomodulatory therapy. We have summarized the current knowledge regarding the impact of COVID-19 infection on autoimmune bullous dermatoses, including recommendations for the main treatment strategies, available patient information, and the registries organized for documentation during the COVID-19 pandemic.
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Affiliation(s)
- Kossara Drenovska
- Department of Dermatology and Venereology, University Hospital "Alexandrovska," Medical University-Sofia, Sofia, Bulgaria.
| | - Snejina Vassileva
- Department of Dermatology and Venereology, University Hospital "Alexandrovska," Medical University-Sofia, Sofia, Bulgaria
| | - Ivan Tanev
- ZRENIE Private Eye Clinic, Sofia, Bulgaria
| | - Pascal Joly
- Department of Dermatology, Rouen University Hospital and INSERM U905, Centre de référence des maladies bulleuses autoimmunes, Normandie University, Rouen, France
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Bardazzi F, Abbenante D, Filippi F, Sacchelli L, Loi C. The initial experience of COVID-19 vaccination in autoimmune blistering diseases patients from a reference care center in Italy. Dermatol Ther 2021; 34:e15057. [PMID: 34232544 PMCID: PMC8420445 DOI: 10.1111/dth.15057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/05/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Federico Bardazzi
- Division of Dermatology, IRCCS Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italy
| | - Diego Abbenante
- Division of Dermatology, IRCCS Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italy
| | - Federica Filippi
- Division of Dermatology, IRCCS Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italy
| | - Lidia Sacchelli
- Division of Dermatology, IRCCS Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italy
| | - Camilla Loi
- Division of Dermatology, IRCCS Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italy
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DEMİRBAŞ A, ELMAS ÖF, ATASOY M, ULUTAŞ DEMİRBAŞ G, TÜRSEN Ü, LOTTI T, KİLİTCİ A. A Case of COVID-19 in a patient with Pemphigus successfully managed with favipiravir. KONURALP TIP DERGISI 2021. [DOI: 10.18521/ktd.896761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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8
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Sinagra JL, Vedovelli C, Binazzi R, Salemme A, Moro F, Mazzanti C, Didona B, Di Zenzo G. Case Report: Complete and Fast Recovery From Severe COVID-19 in a Pemphigus Patient Treated With Rituximab. Front Immunol 2021; 12:665522. [PMID: 33936104 PMCID: PMC8087171 DOI: 10.3389/fimmu.2021.665522] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/29/2021] [Indexed: 01/08/2023] Open
Abstract
COVID-19 is characterized by a severe pulmonary disease due to severe acute respiratory syndrome (SARS)-CoV-2 infection. For clinicians involved in the management of patients with chronic autoimmune diseases the risk linked to the conditions itself and to drug-induced immunosuppression during the COVID-19 pandemic is a major topic. Pemphigus is a rare autoimmune blistering disease (AIBD) of the skin and mucous membranes caused by autoantibodies to desmosomal components, desmoglein 1 and 3. Among immunosuppressant therapies, rituximab (RTX) is considered a highly effective treatment with a favorable safety profile, but it induces a prolonged B-cell depletion that can lead to higher susceptibility to infections. For this reason, concerns about its use during the pandemic have been raised. We describe a case of a pemphigus patient in which RTX-induced B cell depletion led to the severe inflammatory phase, whereas corticosteroid treatment allowed a favorable outcome.
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Affiliation(s)
| | - Claudio Vedovelli
- Department of Infectious Diseases, Central Hospital of Bolzano, Bolzano, Italy
| | - Raffaella Binazzi
- Department of Infectious Diseases, Central Hospital of Bolzano, Bolzano, Italy
| | - Adele Salemme
- Molecular and Cell Biology Laboratory IDI-IRCCS, Rome, Italy
| | - Francesco Moro
- Molecular and Cell Biology Laboratory IDI-IRCCS, Rome, Italy
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Uzuncakmak TK, Özkoca D, Askin O, Kutlubay Z. Can rituximab be used in the treatment of pemphigus vulgaris during the COVID-19 pandemic? Dermatol Ther 2020; 34:e14647. [PMID: 33296557 PMCID: PMC7883057 DOI: 10.1111/dth.14647] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/23/2020] [Accepted: 12/03/2020] [Indexed: 12/17/2022]
Abstract
Rituximab is a monoclonal antibody that targets CD20, a B‐lymphocyte antigen; that leads to a decline in the B‐cell counts for at least a year. The patients who have received rituximab treatment in the previous 5 years with the diagnosis of pemphigus group of diseases at Cerrahpaşa Medical Faculty were questioned for COVID‐19 infection. A total of 48 patients were included in this study; only one male patient had COVID‐19 infection which had a mild course. There is no significant difference in the total number of lymphocytes between patients who have received rituximab within the previous 5 years or last year. The number of lymphocytes is independent of the number of courses of rituximab treatment received. Therefore, we suggest that all pemphigus patients who have received rituximab treatment within the previous 5 years should be careful of the preventive measures against the COVID‐19 infection irrespective of the number of treatment courses or the number of years which has passed since the treatment. The disease course was mild in the only infected patient. Thus, rituximab may be used in the treatment of pemphigus vulgaris during the COVID‐19 pandemic if its use is necessary.
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Affiliation(s)
- Tugba Kevser Uzuncakmak
- Cerrahpasa Medical Faculty, Department of Dermatology, Istanbul University, Istanbul, Turkey
| | - Defne Özkoca
- Cerrahpasa Medical Faculty, Department of Dermatology, Istanbul University, Istanbul, Turkey
| | - Ozge Askin
- Cerrahpasa Medical Faculty, Department of Dermatology, Istanbul University, Istanbul, Turkey
| | - Zekayi Kutlubay
- Cerrahpasa Medical Faculty, Department of Dermatology, Istanbul University, Istanbul, Turkey
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